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ACL re-injuries are six times more likely for athletes after ACL reconstruction and return-to-sport
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CHICAGO — According to a presenter here, athletes who sustained an ACL injury are at greater risk for subsequent ACL injuries during the first 2 years after reconstruction and return-to-sport compared to athletes who have not had an ACL injury.
“Our second injury rate in the first 24 months is relatively high. We see more contralateral injuries in female athletes than ipsilateral re-tears in the ACL reconstruction cohort, and the second ACL injury seems to occur early on after the return-to-sport,” said Mark V. Paterno, PT, PhD, MBA, SCS, ATC, from the Cincinnati Children’s Hospital, said at the American Orthopaedic Society for Sports Medicine Annual Meeting.
Mark V. Paterno
Paterno and colleagues studied the incidence rate of a second ACL injury in the 2 years following ACL reconstruction and return-to-sport in a young, active population. They hypothesized the incidence rate of a subsequent ACL injury would be less than the incidence rate reported within the first 12 months after return-to-sport, but greater than the ACL injury incidence rate in an uninjured cohort of young athletes.
In their prospective study, the investigators enrolled 78 patients (59 women, 19 men) aged 10 years to 25 years who underwent ACL reconstruction and returned to a pivoting/cutting sport and compared them to 47 healthy, control athletes (34 women, 13 men) without a history of ACL or lower extremity injury. All athletes were playing a pivot/cut sport for more than 50 hours per year. Each athlete was followed for injury and athletic exposure data.
Paterno and colleagues found 23 patients in the ACL reconstruction group and four athletes in the uninjured group had an ACL injury during the 24-month period. The overall incidence rate of a second ACL injury within 24 months after ACL reconstruction and return-to-sport was nearly six times greater than uninjured group.
Female athletes who had an ACL reconstruction showed a four times greater rate of injury within 24 months of return-to-sport than the female control athletes. Within the ACL reconstruction group, the female athletes were two times more likely to have a contralateral injury, he said.
Overall, 29.5% of athletes had a second ACL injury within 24 months of return-to-sport with 20.5% having a contralateral injury and 9% having an ipsilateral graft re-tear injury. More women (23.7%) had a contralateral injury than men (10.5%).
Reference:
Paterno MV. Paper #2. Presented at the American Orthopaedic Society for Sports Medicine Annual Meeting; July 11-14, 2013; Chicago.
Disclosure: Paterno has no relevant financial disclosures.
Perspective
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Philippe Neyret, MD
The study by Paterno and colleagues from Ohio highlighted the incidence of a second ACL injury 2 years after primary ACL reconstruction and the athletes’ return to sport. Their 24-month outcome data, analyzed in conjunction with their recent 12-month outcome data which noted a 15 times greater risk of ACL injury compared to healthy athletes, indicate that the greatest risk of a second ACL injury after ACL reconstruction occurs during the initial 12 months after ACL reconstruction and return-to-sport than in the second year after the athletes return-to-sport. There is still some debate about the reason for higher risk after in the first 12 months after ACL reconstruction. Is it due to a too early return muscular? Is it due to the biology of the graft or other predisposing factors? Or is the type of graft used?
The take-home message of this study is that orthopedic surgeons should not have their patients return to contact and pivot sports too early. They also need to prevent ACL injury of the contralteral knee, particularly in females.
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